다양한 신질환을 가진 소아에서 Cystatin C 검사의임상적 유용성
The Clinical Usefulness of Cystatin C in Evaluating RenalFunction in Children with Various Renal Diseases
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목 적 : 사구체 여과율은 신손상 정도와 진행을 예측하는데 중요한 척도이다. 현재까지는 혈청 creatinine을 광범위하게 사용하고 있으나 creatinine의 많은 단점으로 인해 새로운 내부표지자의 필요성이 대두되었고 cystatin C가 새로운 신기능 지표로 주목을 받고 있다. 이에 본 연구는 cystatin C의 유용성을 확인하고자 creatinine과 비교하여 연구를 진행하였다. 방 법 : 2004년 8월부터 2006년 12월까지 연세대학교 세브란스 병원 소아과를 내원한 환자들로서 다양한 신질환을 가지고 있는 43명(총 검사 횟수는 60회)을 대상으로 하였으며 creatinine, cystain C, creatinine 청소율을 측정하였고 creatinine 청소율이 감소된 환자를 그 정도에 따라 3군(Group 1 : CrCl < 40mL/min/1.73m2, Group 2 : CrCl 40-60 mL/min/1.73m2, Group 3 : CrCl > 60 mL/min/1.73m2)으로 나누어 비교하였다. 결 과 : Creatinine 청소율과 1/cystatin C 및 1/creatinine의 상관성을 분석하였고 각각의 상관계수는 0.685(P<0.01)와 0.640(P<0.01)이였다. Creatinine 청소율이 80 mL/min/1.73m2 이하로 감소함을 검출할 진단적 정확도는 ROC curve로 분석한 결과 AUC가 cystatin C와 creatinine에서 각각 0.829, 0.826로 큰 차이를 보이지 않았다(P= 0.848). Creatinine clearance가 40 mL/min/1.73 m2 이상에서는 cystatin C가 creatinine보다 높은 민감도를 보이고 있었다(Group 1 : 100% vs. 100 %, Group 2 : 70% vs. 35%, Group 3 : 46% vs. 15%). 결 론 : Cystatin C는 사구체 여과율을 측정하기 위한 유용한 내부 표지자이며 신기능 손상을 creatinine 보다 일찍 발견할 수 있다는 점에서 향후 신손상 검출을 위한 선별 검사로서 유용성이 높을 것으로 생각된다.
Abstract
Purpose : GFR(glomerular filtration rate) is a fundamental parameter in detecting renal impairment and predicts the progression of renal disease. Because serum creatinine has several disadvantages, serum cystatin C has been recently proposed as a new endogenous marker for GFR. We compared serum cystatin C with creatinine and creatinine clearance to investigate the clinical usefulness of cystatin C. Methods : We retrospectively analyzed 46 patients(60 case numbers) who had various renal diseases and classified them into 3 groups according to creatinine clearance(Group 1 : CrCl <40 mL/min/1.73m2, Group 2 : CrCl 40-60 mL/min/1.73m2, Group 3 : CrCl >60 mL/min/1.73 m2). We measured serum creatinine, cystatin C and creatinine clearance and also analyzed the correlations among them. Results : Serum cystatin C and creatinine showed a similar correlation to creatinine clearance (r=0.685, r=0.640, respectively) and showed similar diagnostic accuracy in detecting decreased GFR(AUC, cystatin C 0.829 vs. creatinine 0.826, P=0.848). Serum cystatin C showed a greater sensitivity for detecting a decreased GFR than creatinine in Group 2 and 3(Group 1 : 100% vs. 100%, Group 2 : 70% vs. 35%, Group 3 : 46% vs. 15%). Conclusions : Serum cystatin C could be a useful endogenous marker for GFR and would be superior to serum creatinine in early detection of renal impairment in pediatric patients with renal diseases.
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